Summary: The “Dream Act” seemed to come and go so quickly in the news cycle. Legislation to repeal “Don’t Ask, Don’t Tell,” plus the hoped-for treaty with the  Soviets  pushed the failed bill off the media’s radar screen.

I wrote this post Saturday, but then didn’t put it up on Health Beat because I felt I wasn’t adding anything new to the debate. (Ask long-time Health Beat readers “What do you think Maggie thinks about the Dream Act”? and many could probably write the post themselves.) But as I thought about it, it seems to me that I do have something to say.

We should stop to grieve for these students. And we should put the Dream Act at the top of a liberal agenda next year. I realize that as the Tea Party joins Congress, it will be harder to welcome new immigrants to this country. But the Latino vote will be extraordinarily important in 2012. If only for political reasons, liberals should show their support for this legislation—and force conservatives to try to justify cutting off opportunities for 17-year-olds who live in this country.
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When the Obama-McConnell tax compromise passed the House last week, 112 Democrats voted against the legislation. Just 139 Democrats supported the bill. The split within President Obama’s own party underlines the uncertainty as to whether passage of the legislation really represented a “win” either for the president–or for the country.

Bloomberg that “Representative David Obey, a Wisconsin Democrat who is retiring after 40 years,” was among those who expressed his disgust with the deal. “’Wonderful,' he said, as he left the House floor for one of the last times in his career. “Just what we need: [a law that] further exacerbates income inequality in this country.”

“It is a huge giveaway to the super-rich in these tough economic times,” added Representative Jim McDermott, a Washington Democrat. “It just boggles the mind. It’s indefensible, unconscionable.”

According to Bloomberg, even House Speaker Nancy Pelosi, who played the role of a loyal lieutenant by selling the legislation to House liberals, sounded less than thrilled: “I salute President Obama for getting in the bill what is in there,” she said. “I’m sorry for the price that has to be paid by our children and our grandchildren to the Chinese government,” she added, referring to the fact that this bill will add $860 billion, plus interest, to the deficit– for a total of more than $1 trillion. (China is among the many foreign investors who buy our Treasuries, lending us the money needed to carry an extraordinary amount of debt. As of July 2010, the U. S. Treasury reports that China owned $846.7 billion, or 20.8 percent of U.S. debt held by foreigners.)

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When President Obama struck a deal with conservatives on tax cuts, his opponents set the stage for 2012. With this legislation, the conservative agenda of the Bush administration once again becomes national policy. The goal: to redistribute wealth upward–even if that means letting the deficit balloon.
Not long ago, conservatives on the Deficit Commission were warning that the deficit represents a “cancer” that will "destroy the country from within."

Now, politicians on the right are arguing for tax cuts that will add $858 billion to the deficit over ten years—plus $383 in interest over the same span—bringing the total impact on the national debt to $1.24 trillion through 2020. And somehow, that is suddenly a brilliant idea?

Trust me, there is a method to Mitch McConnell’s madness: The larger the deficit, the more compelling the conservative case for  shrinking entitlements such as  Medicare, Medicaid, Social Security and Health Care reform in 2012.

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Thanks to the new health care bill, beginning in 2014, insurers will not be able to set annual caps on medical coverage. Already, since September 23, annual coverage limits on health care costs can be set no lower than $750,000. The idea is that most insured Americans can rest assured that even in the event of a catastrophic illness, their policies will help offset the bulk of their medical expenses. Note that I wrote, most Americans. This provision doesn’t apply if you happen to be one of the 1.5 million mainly low-income workers covered under limited-benefit plans—the so-called “mini-med” plans—offered by McDonalds, Waffle House and other employers that hire low-wage employees.

In October, Joe Barton (R-TX), ranking member of the House Committee on Energy and Commerce and two other Republican subcommittee members, sent a letter to Kathleen Sebelius registering their concern that the new provisions in the health care law would force insurers and employers that offer mini-med plans to drop out of the business. McDonald's, for one, warned regulators that high administrative costs might lead to the company dropping its health insurance plans for 30,000 hourly workers unless it was exempted from this policy.

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It’s nice to know that the liberals are not the only politicians who know how to form a circle, and then shoot directly into the center.

Today, with a critical procedural vote on the tax deal scheduled in the Senate, some Tea Party activists and other conservatives are denouncing an agreement that gives the Republican leadership virtually everything that they might conceivably hope to win from the White House. 

Not satisfied, the party’s right wing is launching an attack. According to The New York Times “a group called the Tea Party Patriots is circulating a petition accusing Republican lawmakers of cutting a bad, backroom deal with the president that violates the principles that Tea Party candidates campaigned on during the midterm elections.

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Over the weekend, the New York Times published a head-turning tale about Dr. Mark Midei, a star cardiologist at St. Joseph Medical Center in Townson, Maryland. According to federal investigators, Dr. Midei implanted potentially dangerous cardiac stents in the arteries of as many as 585 patients who didn’t need them. A hard worker, he managed to knock off those 585 procedures in just two years, from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for the treatments.

The Baltimore Sun broke Dr. Midei’s story in January. In February the U.S. Senate Committee on Finance, which oversees Medicare and Medicaid, began investigating. Monday, the Finance Committee released a 1200-page report.

The report reveals that Midei was a favorite son of Abbott Laboratories, the company that manufactured the stents. Indeed, in August of 2008, Abbott celebrated the fact that the handy doctor had inserted 30 of the company’s cardiac stents into trusting patients in a single day: “Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home.”  Employees from St. Joseph’s attended the feast.

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Below, a guest post by Dr. Nortin M. Hadler, MD MACP MACR FACOEM
Professor of Medicine and Microbiology/Immunology, School of Medicine University of North Carolina at Chapel Hill and Attending Rheumatologist, UNC Hospitals

The 5-year mortality for a well man after his first heart attack has dropped from 50% to 5% in one generation. The line of people who are taking credit for this happy turn of events is very long. At the head of the line stand the cardiovascular surgeons and interventional cardiologists. They bask in the praise of the media and of their celebrity patients who consider them saviors. If you have survived one of these modern medical miracles unscathed, you feel blessed to live in such a medically advantaged community. If symptoms return, it seems so reasonable to return to this technological fountain. If you survived scathed or ultimately succumb, it means that even modern medical miracles were no match for the magnitude of your affliction.

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Today, “The National Commission on Fiscal Responsibility and Reform” a bi-partisan group that President Barack Obama appointed earlier this year, released the final version of a report recommending ways to rein in the budget deficit.  I’m not going to try cover all of the Commission’s proposals in this post, but I think it’s important to compare how the Accountable Care Act reins in Medicare spending to the Commission’s more Draconian approach.

The commission takes aim at healthcare for seniors by hiking co-pays and deductibles for Medicare patients without considering what patients can afford. Under these proposals, many middle-class Medicare beneficiaries will not be able to afford health care. Those who are sickest would suffer most. The report then blindly freezes and ultimately cuts Medicare payments to all physicians–ignoring the fact that, today, some are underpaid for essential services.  Finally, it calls for reinstating the dreaded sustainable growth rate (SGR) formula as a benchmark for reducing reimbursements to physicians, beginning in 2015.

Friday, the 18-member panel will vote on the plan. If 14 members of the group say “yea,” it will go to Congress for its consideration.  

 How the Fiscal Commission Would Reduce Medicare Payments to Doctors: The commission’s co-chairs, Alan Simpson and Erskine Bowles, released an outline of the report on November 10 which called for "modest reductions" in Medicare reimbursement for physicians, but did not specify an amount. Today's full-fledged report unveils the numbers.

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 Yesterday the Federal Trade Commission proposed a broad framework for protecting consumer privacy both on the Web and off-line. The framework is meant to help guide policymakers in crafting legislation to prevent the tracking and wholesale collection and sale of consumer information that is practiced by large on-line companies like Google, Mozilla, and Microsoft. Yesterday I wrote about health information “data mining;” (see post below) the collection and sale specifically of web-user’s health data, including the conditions they suffer from, medications used and identification information like name, age, gender and even personal doctor. As the FTC notes in its proposal; “The more information that is known about a consumer, the more a company will pay to deliver a precisely-targeted advertisement to him."

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A year ago, I wrote about how pharmaceutical companies are increasingly paying third parties like IMS Health or CVS-Caremark to provide them with the prescribing records and identification information for individual doctors. Armed with this information, drug companies—sometimes taking on the role of “concerned experts”—can tailor their marketing directly to these doctors; visiting their offices and sending them letters and informational material suggesting that they use a different (usually newer and more expensive) medication for certain patients or suggest that they adjust dosages. 

This practice, called data-mining, is a highly lucrative business (In 2005, data mining provided IMS alone with revenues of $1.75 billion) that is rapidly replacing direct-to-consumer advertising as the preferred form of pharmaceutical marketing. Data miners will have an even easier time amassing the information they sell to companies as more physicians and practices adopt electronic health records. Prescribing information about patients is coming from other sources too: Websites designed to help patients connect with others suffering from the same disease (breast cancer, Parkinson’s disease, fibromyalgia, etc.) have also started selling information about which medications their members use to drug companies. And even the American Medical Association is in on the game; last year the group garnered $44 million in profits by selling physician profile information that data miners like IMS use to blend with prescribing records to help drug companies target individual doctors.

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